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PURPOSE: In December 2019, a new coronavirus (SARS-CoV-2) was identified as being responsible for the pulmonary infection called COVID-19. On 21 February 2020, the first autochthonous case of COVID-19 was detected in Italy. Our goal is to report the most common chest computed tomography (CT) findings identified in 64 patients, in the initial phase of COVID-19. METHODS: Sixty-four chest high-resolution computed tomography (HRCT) examinations performed at the Radiology Unit of the Hospital of Cremona, from 22 to 29 February 2020, of 64 patients during first week of hospitalization for COVID-19 were retrospectively evaluated. All cases were confirmed by real-time RT-PCR for SARS-CoV-2. Image analysis was independently conducted by 2 radiologists with 10 years and 1 year of experience in chest imaging. The inter-observer agreement was obtained by applying a Cohen's κ test. RESULTS: The average age of patients was 67.1 years (± 12.2); men 42 (66%). HRCT was performed on the 5th (± 1.5) day of hospitalization. More frequently, the initial CT changes of the lung show more or less extensive areas of ground-glass, as single pattern or with parenchymal consolidations. Coronavirus lung involvement appears very frequently multi-lobar, bilateral, and it concerns both subpleural and central regions. An excellent agreement (κ: 0.88-1, CI: 0.79-1.01, p < 0.05) concerning CT findings between the 2 operators was reached. CONCLUSIONS: Our data suggest that detection of the most frequent pulmonary CT-scan changes, in the early stages of COVID-19, can be performed, with excellent agreement, among readers with different experience, and consequently attribute their exact diagnostic value, in an appropriate clinical and environmental exposure setting.
ABSTRACT
BACKGROUND: Coronavirus disease 2019 (COVID-19) has spread worldwide determining dramatic impacts on healthcare systems. Early identification of high-risk parameters is required in order to provide the best therapeutic approach. Coronary, thoracic aorta and aortic valve calcium can be measured from a non-gated chest computer tomography (CT) and are validated predictors of cardiovascular events and all-cause mortality. However, their prognostic role in acute systemic inflammatory diseases, such as COVID-19, has not been investigated. OBJECTIVES: The aim was to evaluate the association of coronary artery calcium and total thoracic calcium on in-hospital mortality in COVID-19 patients. METHODS: 1093 consecutive patients from 16 Italian hospitals with a positive swab for COVID-19 and an admission chest CT for pneumonia severity assessment were included. At CT, coronary, aortic valve and thoracic aorta calcium were qualitatively and quantitatively evaluated separately and combined together (total thoracic calcium) by a central Core-lab blinded to patients' outcomes. RESULTS: Non-survivors compared to survivors had higher coronary artery [Agatston (467.76 â± â570.92 vs 206.80 â± â424.13 âmm2, p â< â0.001); Volume (487.79 â± â565.34 vs 207.77 â± â406.81, p â< â0.001)], aortic valve [Volume (322.45 â± â390.90 vs 98.27 â± â250.74 mm2, p â< â0.001; Agatston 337.38 â± â414.97 vs 111.70 â± â282.15, p â< â0.001)] and thoracic aorta [Volume (3786.71 â± â4225.57 vs 1487.63 â± â2973.19 mm2, p â< â0.001); Agatston (4688.82 â± â5363.72 vs 1834.90 â± â3761.25, p â< â0.001)] calcium values. Coronary artery calcium (HR 1.308; 95% CI, 1.046-1.637, p â= â0.019) and total thoracic calcium (HR 1.975; 95% CI, 1.200-3.251, p â= â0.007) resulted to be independent predictors of in-hospital mortality. CONCLUSION: Coronary, aortic valve and thoracic aortic calcium assessment on admission non-gated CT permits to stratify the COVID-19 patients in-hospital mortality risk.
Subject(s)
COVID-19/mortality , COVID-19/physiopathology , Computed Tomography Angiography , Vascular Calcification/mortality , Vascular Calcification/physiopathology , Aged , Aged, 80 and over , Aorta, Thoracic/diagnostic imaging , Aortic Diseases/diagnostic imaging , Aortic Diseases/mortality , Aortic Diseases/physiopathology , Aortic Valve/diagnostic imaging , COVID-19/diagnostic imaging , Coronary Vessels/diagnostic imaging , Female , Humans , Italy/epidemiology , Male , Middle Aged , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/mortality , Pneumonia, Viral/physiopathology , Pneumonia, Viral/virology , Predictive Value of Tests , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , Vascular Calcification/diagnostic imagingSubject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19 Drug Treatment , Carcinoma, Non-Small-Cell Lung/drug therapy , Immune Checkpoint Inhibitors/therapeutic use , Lung Neoplasms/drug therapy , SARS-CoV-2 , Aged , Antibodies, Monoclonal, Humanized/adverse effects , Humans , Immune Checkpoint Inhibitors/adverse effects , MaleSubject(s)
HIV Infections/complications , Thrombosis/etiology , Anti-HIV Agents/therapeutic use , Anticoagulants/therapeutic use , Antiretroviral Therapy, Highly Active , Female , HIV Infections/drug therapy , Heparin/therapeutic use , Humans , Middle Aged , Thrombosis/diagnostic imaging , Thrombosis/drug therapyABSTRACT
Congenital absence of pericardium (CAP) is a rare condition, generally asymptomatic or paucisymptomatic, nevertheless sporadic cases complicated by sudden death are described. CAP can be diagnosed by CT and MRI. It is classified as total or partial, and partial defects are divided into left defects and right defects. Interestingly, several articles highlight the correlation between CAP and some anatomical lung abnormalities, such as presence of lung parenchyma between the main pulmonary artery and ascending aorta, lung parenchyma between the base of the heart and left hemidiaphragm, and lung parenchyma between the proximal ascending aorta and right pulmonary artery.
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PURPOSE: The aim of this study was to assess computed-tomography histogram analysis (CTHA) as prognostic and predictive factor in platinum-refractory non-small cell lung carcinoma (NSCLC) treated with immune checkpoint inhibitor Nivolumab. METHOD: One hundred and four patients were enrolled from 3 different centers. CT was performed using similar parameters among different scanners. CTHA was performed with the proprietary software TexRAD, which extracts histogram features at different spatial scale (spatial scale filters, SSF) producing 30 CTHA features per patients. Cross-validated Least Absolute Shrinkage and Selection Operator LASSO was used to select those features which were related to overall and progression-free survival (OS and PFS, respectively). High- and low-risk subgroups were identified using the best cutoff. RESULTS: Median follow-up was 13.8 weeks. Median OS and PFS were 7.3 and 3 months, respectively. LASSO selected kurtosis obtained by SSF = 4 mm as the single feature related to OS, leading to an hazard ratio (HR) of 0.476 (95%CI 0.29-0.77). PFS was related with kurtosis SSF = 6 mm, with HR of 0.556 (95%CI 0.36-0.86). CONCLUSION: Despite its limitations, this study is the first which suggests that CTHA could play a role in stratifying prognosis and treatment response in patients with NSCLC treated with Nivolumab.
Subject(s)
Antineoplastic Agents, Immunological/therapeutic use , Carcinoma, Non-Small-Cell Lung/drug therapy , Lung Neoplasms/drug therapy , Nivolumab/therapeutic use , Adult , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Carcinoma, Non-Small-Cell Lung/mortality , Disease-Free Survival , Drug Resistance, Neoplasm , Female , Humans , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/mortality , Male , Middle Aged , Platinum Compounds/therapeutic use , Prognosis , Proportional Hazards Models , Retrospective Studies , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
Gallstone ileus is a rare case of mechanical intestinal obstruction observed in patients with history of cholelithiasis or cholecystitis. Its diagnosis is difficult and it is characterized by high mortality rate. Diagnostic Imaging plays an important role in the management of patients with suspected gallstone ileus because an early diagnosis could reduce the mortality. Abdominal Computed Tomography (CT) is the preferred modality because of its rapid diagnosis. Surgery remains the gold standard treatment.
Subject(s)
Gallstones/diagnostic imaging , Ileus/diagnostic imaging , Intestinal Obstruction/diagnostic imaging , Humans , Intestinal Obstruction/etiology , Tomography, X-Ray ComputedABSTRACT
Imaging makes a significant contribution to the diagnosis, prognosis and follow-up in sarcoidosis. Despite its increasing use, the role of computed tomography (CT) scanning in patients with known or suspected pulmonary sarcoidosis is still undefined. This review aims to compare the utility and limitations of chest radiograph and CT in patients with pulmonary sarcoidosis, with regards to the most critical clinical issues such as the diagnostic sensitivity, the differential diagnosis, and the prediction of the disease reversibility.
